As we set out in Mission impossible? last year and subsequent events have proved, the 2017/18 trust ask was undeliverable. As set out in this report the 2018/19 ask looks, taking a very optimistic view, at the edge of being deliverable. Being realistic, it looks some way beyond that edge and unachievable.
We set out in the context section why it is so important that the annual provider task is deliverable. Yet the DHSC and its arms length bodies continue to set an unachievable task. What could be done to ensure this doesn’t happen again?
NHS Providers believes four things are needed:
1. A change to the planning process
The current national planning framework is set by DHSC and NHS Improvement/NHS England with Treasury approval and involvement. There is a key missing partner here – the frontline organisations that deliver the planning framework. The DHSC and the ALBs must create a process in which the emerging provider (and commissioner) ask is properly and rigorously tested with the frontline in an appropriate way. This could be through a small representative group whose views are properly listened to and taken account of.
This requires a significant behavioural and process change and will add pressure to an already difficult timetable. But the current approach of the four governmental / ALB parties negotiating the framework privately and announcing the final result to the frontline is no longer credible and needs to change. It is particularly important that there is significant frontline involvement in the development of the 2019/20 planning framework which is likely to involve a major and substantial reset of the context in which providers and commissioners work.
2. A new national planning framework
Future national planning frameworks must be based on the following, which have been lacking in recent approaches:
realistic demand projections that take full and proper account of current demographic trends and the state of other public services, particularly social care
a proper safety and contingency margin against events such as flu outbreaks which can have a significant impact on NHS trusts
realistic assumptions about the speed, size and consistency of delivery of change and transformation benefits that recent national planning frameworks have consistently over estimated
recognition that, after eight years of the longest funding squeeze in NHS history and in the midst of widespread workforce shortages, the NHS is currently inherently unstable and management capacity is in very short supply, given the time and effort needed to ensure day to day operational delivery.
The current national planning framework is set by DHSC and NHS Improvement/NHS England with Treasury approval and involvement. There is a key missing partner here – the frontline organisations that deliver the planning framework.
3. Match the funding to the task in hand
Ensure that the framework matches the task presented to trusts with the funding available. NHS performance statistics over the last three years show that we have clearly now reached the point where the NHS is no longer able to deliver its constitutional standards without significant extra funding and capacity, and a means of addressing current workforce shortages. In the absence of these, the NHS trust task has to be redrawn accordingly.
4. A fully funded, effective, short and long term plan to address the current workforce shortages
Workforce capacity is significantly affecting current trust delivery capability. While we welcome the current draft workforce strategy, it needs a matching clear commitment to fully fund its final conclusions. And we need a more detailed, effective, plan for the short term to fill current gaps while the long term supply envisaged in the strategy comes on stream.